November 8th, 2021
The Out-of-Pocket Health News Digest
Below you will find briefs about recent health policy news stories. Our hope is for students to have an information outlet at their fingertips to keep up-to-date with the most pressing news stories in health policy.
This compilation is produced by the HPSA Education Committee: Brynna Thigpen, Christopher Whitlock, Easheta Shah, Hannah Lane, Hassan Kourani, Jourdan Clements, and Lizzy Peppercorn
Puerto Rico serves as a model for COVID-19 vaccination
by Brynna Thigpen


An unlikely leader has emerged in the race to vaccinate America against COVID-19: Puerto Rico. This small island territory’s population - roughly the same geographic size as Connecticut and with approximately the same population as Utah - exceeds the U.S.’s overall vaccination rate (66.9%), at 71.5%. 89.7% of eligible Puerto Ricans are vaccinated. So how did they do it? 

Avoiding Polarization
The political polarization surrounding governmental shelter-in-place, social distancing, and vaccine directives familiar to many mainland Americans was largely absent from Puerto Rico. Puerto Rico has four major political parties, and each supported vaccination. Messaging was consistent and pro-science. Individual Puerto Ricans’ identities were not tied to whether or not they chose to get vaccinated, making the choice to get inoculated less controversial. 

Trust in Government
The island’s COVID-19 response was co-managed by the government and the National Guard, a force Puerto Ricans know well. The National Guard has guided Puerto Rico through its many natural disasters, from Hurricanes Irma and Maira, to a 6.4-magnitude earthquake that hit in January 2020. Some theorize that the trust Puerto Rican government and emergency preparedness officials have built over these crises, and a sense of duty to cooperate and collectively shoulder responsibility helped Puerto Ricans get vaccinated quickly. When a vaccination mandate was established in late summer, residents complied, further boosting rates. 

Flexible Operational Model
General José Reyes of the National Guard, a preparedness expert, began preparing early on in the pandemic for eventual vaccines, purchasing cold storage capacity and building out a hub-and-spoke model in advance. The day after Pfizer vaccines first left warehouses for states and territories, all 64 Puerto Rican hospitals had vaccines available. When young people were driving the transmission surges, Puerto Rican health officials also sought out the unvaccinated, appearing at bars and beaches to vaccinate patrons. 

Taken together, Puerto Rico’s apolitical approach, a trust in government’s ability to help residents weather a crisis, and nimble operations helped Puerto Ricans to reach the pinnacle of vaccination rates in the U.S. 

Sources: CNN, Stat, NPR, CDC
Pfizer COVID-19 Vaccination Approved for Children Ages 5-11
by Christopher Whitlock
The Pfizer COVID-19 vaccination is now the first pediatric COVID vaccine authorized for use in the United States following a unanimous vote by an expert panel advising the Centers for Disease Control and Prevention and subsequent approval from CDC director Rochelle Walenksy on Tuesday, November 2nd. This approval follows last week’s Food and Drug Administration authorization for the use of Pfizer’s COVID vaccine in children ages 5-11, and it expands vaccine eligibility to include an additional 28 million children.

Pfizer’s pediatric COVID vaccine is one-third the dose of the adult vaccination, and it is administered with two injections 21 days apart. In a study including over 3,000 children who received the pediatric vaccine, researchers found it to be approximately 91% effective in preventing symptomatic COVID infection. While children are less likely than adults to develop severe complications from COVID infection, there have been more than 8,300 children between the ages of 5 and 11 hospitalized with the virus and over 5,000 have developed multisystem inflammatory syndrome (MIS), a severe complication associated with COVID-19.

The CDC reviewed the relatively rare risk of myocarditis, a form of heart inflammation, that can occur following COVID vaccinations during its discussion on Tuesday. Myocarditis normally occurs as a complication of severe viral infections, including COVID, but approximately 877 cases have been reported following the Pfizer or Moderna vaccine in people 30 years of age or younger. No deaths have been reported in this cohort; however, and experts are quick to acknowledge the risk of COVID infection on the heart is far greater than the risk of vaccination.

Vaccine rollout to pediatrician offices across the country following CDC approval has been rapid, with many vaccinations already being administered this week. CDC models have predicted that vaccination of 5- to 11-year-olds starting now could reduce the risk of new variants emerging while preventing up to 600,000 cases of COVID by March 2022. Nearly two full years into the pandemic, this approval marks another turning point in the battle against COVID.
One-Liners
  • Biden compromises on social-spending plan: The Biden administration’s new social-spending framework is a scaled-back version of Biden’s initial “Build Back Better” plan he hopes will pass through Congress. Key health provisions removed from the bill include vision and dental coverage under Medicare, improved home health services, and lowered prescription drug costs (Kaiser Health News, NPR).
  • BBB: On Friday night, President Biden's infrastructure plan, the Build Back Better Act, passed in the House. Six Democrats wanting broader provisions and thirteen Republicans against the price tag voted against their parties; otherwise, the bill was passed mostly along party lines (NYT).
  • New approaches to counter opioid deaths: Given the surge in overdose deaths in the past year, the Biden administration - including HHS Secretary Xavier Becerra - is considering new harm reduction approaches to provide lifelines to those experiencing addiction, like supervised injection sites and fentanyl test strips to identify contaminated street drugs (NPR).